As the largest publicly-funded health system globally, the “NHS delivers 17 million inpatient admissions from more than 200 hospital trusts, more than 270 million primary care appointments from nearly 7,000 general practices and prescribes more than 1.1 billion items every year” (2). The NHS is responsible for about 4% of Britain’s emissions. As former NHS Chief Executive Sir Simon Stevens stated: “[…] as the biggest employer in this country comprising nearly a tenth of the UK economy, we’re both part of the problem and part of the solution”. Having clearly recognised that the climate emergency is also a health emergency, the NHS started the For a Greener NHS programme in January 2020 in order to define a credible path to achieving net-zero emissions (3).
The NHS has set the following climate objectives:
- for the emissions the NHS controls directly (the NHS Carbon Footprint), net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032
- for the emissions the NHS can influence (the NHS Carbon Footprint Plus), net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039.
The distinction of emissions follows the Greenhouse Gas (GHG) Protocol scopes, whereby the NHS Carbon Footprint comprises direct emissions (Scope 1), indirect emissions related to the consumption of electricity (Scope 2), as well as the share of the Scope 3 emissions the NHS controls directly, such as business travel, waste or water. The NHS Carbon Footprint Plus includes all emissions the NHS does not directly control, but can influence, including emissions that occur in the supply chain (4). In 2019, the NHS Carbon Footprint Plus was estimated at 25 MtCO2e, the NHS Carbon Footprint at 6.1 MtCO2e (5).
NHS Carbon Footprint Plus and the role of supply chain emissions
The largest share of emissions by far occurred in the supply chain (62 % or 15.6 MtCO2e), mostly from the manufacturing of goods such as pharmaceuticals and chemicals (32% of total supply chain emissions or 5.1 MtCO2e), as well as medical equipment (19% of total supply chain emissions or 3.0 MtCO2e) (6). Supply chain emissions include freight, the manufacturing of goods, catering, business services and construction. The NHS has a large supplier base, with more than 80,000 suppliers – getting them on board to decarbonise their products and production processes is a key challenge, but also an opportunity to drive ambitious climate action.
The NHS approach to reducing supply chain emissions
The NHS identified three major levers to reduce emissions from the NHS supply chain and to deliver the net zero targets (7):
- more efficient use of supplies
- low-carbon substitutions and product innovation
- ensuring suppliers are decarbonising their own processes
The decarbonisation of suppliers has been identified as the single most impactful activity in reducing the NHS Carbon Footprint Plus in the NHS “Delivering a Net Zero National Health Service” report (8).
To make this happen, the NHS has set out clear and transparent expectations for their supplier. By the end of the decade, the NHS will no longer purchase from suppliers that do not meet or exceed its net zero requirements. This goal was further broken down into milestones suppliers have to meet to continue being accepted by the NHS in the short and medium term – the NHS Supplier Roadmap outlines that pathway:
|From April 2022||All NHS procurements will include a minimum 10% net zero and social value weighting. The net zero and social value guidance for NHS procurement teams will help unlock health-specific outcomes.|
|From April 2023||For all contracts above £5 million per annum, the NHS will require suppliers to publish a carbon reduction plan for their UK Scope 1 and 2 emissions and a subset of scope 3 emissions as a minimum.|
|From April 2024||The NHS will extend the requirement for a carbon reduction plan to cover all procurements.|
|From April 2027||All suppliers will be required to publicly report targets, emissions and publish a carbon reduction plan for global emissions aligned to the NHS net zero target, for all of their Scope 1, 2 and 3 emissions.|
|From April 2028||New requirements will be introduced overseeing the provision of carbon foot printing for individual products supplied to the NHS. The NHS will work with suppliers and regulators to determine the scope and methodology.|
|From 2030||Suppliers will only be able to qualify for NHS contracts if they can demonstrate their progress through published progress reports and continued carbon emissions reporting through the Evergreen sustainable supplier assessment.|
In addition to the net zero roadmap, the NHS will adopt the UK government’s procurement policy Social Value Model.Which means that all NHS tenders must include a minimum 10% weighting on net zero and social value.
Bringing suppliers on board
A group of leading suppliers has quickly taken the lead and pledged to support a net zero health service. Made up of businesses (for example, GSK, Medtronic, Johnson & Johnson, Novo Nordisk), trade bodies and independent members, the “International Leadership Group for a Net Zero NHS” stated: “We understand that taking action on this agenda is complex, not least because our supply chains are global. It will require strong leadership, bold commitments, and a clear roadmap with intermediate targets. But it is critical if we are to support a healthier planet and healthier people” (10).
Whilst some NHS suppliers are already on a decarbonisation path, others are only at the beginning of the journey. The NHS has engaged extensively with suppliers through supplier forums, surveys and engagement with key trade bodies to better understand the most important barriers and opportunities. To this end, the NHS regularly convenes a Sustainable Supplier Forum to accompany and support suppliers on the joint net zero journey.
A supplier assessment to benchmark themselves against NHS requirements and to communicate achievements will be put in place in 2023, initially voluntarily. Furthermore, small and medium enterprises (SMEs) and voluntary, community and social Enterprises (VCSEs) are granted a two-year grace period on the key milestones leading up to the 2030 deadline to give them time to get ready for the new requirements (11).
Sarah Ouanhnon quote
“Achieving the NHS net zero commitment will only be feasible if we bring everyone on the journey, patients, staff, suppliers, and broader partners. We have listened to suppliers’ feedback and have outlined a clear roadmap, allowing suppliers to plan their own net zero journey and align with the NHS ambition.”
A considerable journey lies ahead of the NHS – and its 80,000 suppliers. To decarbonise its supply chain, the NHS is not only looking to decarbonise its suppliers, but also the procured goods and services. First steps have been taken to reuse and refurbish (12) devices, such as crutches, frames and walking sticks. The NHS, in partnership with SBRI (Small Business Research Initiative) Healthcare is also actively seeking out innovations to support the delivery of a Net Zero NHS. Together they set up a competition programme (13) that awarded £1 million to ten pioneering medical and digital innovations
Greening suppliers – and the supplies
(1) NHS, Delivering a Net Zero National Health Service, 2020. Read here
(2) Tennison, Imogen et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England, 2021. Read here
(3) NHS, Greener NHS campaign to tackle climate ‘health emergency’, 2020. Read here.
(4) The NHS chose to go beyond the requirements of the GHG Protocol in the calculation of their emissions by also including patient and visitor travel, part of the NHS Carbon Footprint Plus. For further details see NHS, Delivering a Net Zero National Health Service p. 10, 2020
(5) NHS, Delivering a Net Zero National Health Service, 2020. Read here
(6) Tennison, Imogen et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England, 2021. Read here
(7) NHS, Delivering a Net Zero National Health Service p.28, 2020. Read here
(8) NHS, Delivering a Net Zero National Health Service p.17, 2020. Read here
(9) NHS, Delivering a Net Zero NHS – One Year Progress. 30 September 2021. Read here
(10) International Leadership Group for a Net Zero NHS: A commitment to decarbonise by 2045: an open letter to all NHS suppliers, 2021. Read here
(11) NHS, Delivering a Net Zero NHS – One Year Progress. 30 September 2021. Read here
(12) NHS – Reducing the environmental impact of equipment, medicines and resources. Read here
(13) SBRI Healthcare Awards £1 Million To Pioneering Innovations To Support The Delivery Of A Net Zero NHS, 2022. Read here
Cover photo © Anna Shvets/Pexels.